CPAP Air Blowing Out of Mouth

[Akhenaten33]

I worked over the last 3 months to get my Flex, Pressure and Mask settings just right and was able to get my treated AHI down from 11.0 or so, and regularly under 3.0.  However, as I stepped up the MIN pressure over the months in an effort to reduce my AHI, I noticed that now at times (75% of the nights) the air pressure will simply blow out of my mouth, and appear as a Large Leak on my charts - even though my nasal pillow mask fit is great.  And of course be associated with a jump in AHI to 4.0 - 5.5.

I have always kept my mouth closed at night when I sleep.  This air is actually pushing through between my teeth and forcing my lips to flap like a deflating balloon. So just simply having my mouth closed (with a jaw strap for example) is not enough.

I don't like full face or whole nose masks because I have sensitive skin and rosacea - and where the mask comes into contact with my skin I get painful, red autoimmune welts filled with puss.

I do not get as good a rest at 4.0+ I can tell.  AND my spouse keeps nudging me because the air exiting my mouth through my teeth, sounds like a deflating balloon and keeps her up.

Is there a mouthpiece seal out there, or a technique anyone has tried. This is occurring even with my teeth clenched shut. 

[mesenteria]

If a collar or the strap don't work, especially after several looooonnnng nights of trying to cover daily variance, then you may have to do what I and many others do...tape.  3M's NexCare 2.5 cm wide water-resistant tape does a good job.

I fold a tiny fold at one end to make removal in a panic easy and likely.  Blow out your lips with lips pursed, and apply a length that extends about 1.5 cm past the corners of you mouth.  Press it all well into place, everywhere.

I have done this since Night Two.  I had no choice, and still don't.

You may be sleeping more deeply now, as well, since the therapy doesn't correct everything in one night.  As we adapt, become more comfortable, and respond therapeutically, usually over many weeks, our sleep may change and we get into progressively deeper levels longer.  It may mean lip flapping where it didn't happen previously.

[Kosoku]

I use 3M medical tape and a soft cervical collar. This stops my mouth breathing as long as I remember to go no more than 2 days without shaving. the things we have to do.
Someone will chime in soon on the tongue suck technique which will work, just not immediately.

[OpalRose]

You can practice this technique anytime, during the day and at night. Eventually keeping your tongue in place will come natural.

Tongue Suck Technique:
Place your tongue to the roof of your mouth with tip of tongue behind front teeth.  Slowly suck upwards and back.
This places the tongue in a natural position, with the back of tongue sealing the back of the throat so that if you open your mouth/jaw while sleeping, no air will escape.

[Akhenaten33]

You can practice this technique anytime, during the day and at night.  Eventually keeping your tongue in place will come natural.

Tongue Suck Technique:
Place your tongue to the roof of your mouth with tip of tongue behind front teeth.  Slowly suck upwards and back.
This places the tongue in a natural position, with the back of tongue sealing the back of the throat so that if you open your mouth/jaw while sleeping, no air will escape.

Opal, I thought this was a problem which many have had to face. This tongue suck I have actually tried after finding ways to stop the blow though. The majority of the blow through leaks do occur nearer to the early hours, 4 or 5 am, after my tongue has worked its way free from its early night position.

Possibility: will a silicone tongue retainer, like those used for snoring, possibly stop this blow through?  I have a 5-9 day beard which I wear at all times, and I have oily and acidic skin, so tape usually does not do well with me... 

[OpalRose]

I don’t know anything about silicone tongue retainers.  Just googling, and it looks like it’s meant to hold the tongue in a forward position.   Mabye someone else here has tried them.

[sheepless]

my wife and i used a tongue advancement thingy before I had apap. results are purely subjective (no data). I believe it did reduce snoring a bit but was pretty uncomfortable and allowed lots of drooling. my wife gave up after only a couple nights. I gave it up when I started apap. I did try it once with apap before I had a cervical collar and had too many mouth leaks. been on my mind to try again with c collar. will report if when I do.

[MrZennie]

I had the same problem, even at very low pressures. I tried Somnifix mouth tape and it works great! But the 3M tape mentioned above is probably a much cheaper solution.

[Akhenaten33]

OK, what I will do it try the tape first. Then if that does not work - I will try the tongue thing... in theory it seems like it would provide a barrier at the lips, to prevent the blow though leak effect.

Thanks!

[sheepless]

tape doesn't work for me due to facial hair and I have not been able to master the tongue suck. I entertained the idea of using some kind of pacifier and that's when I tried the tongue advancer holder bulb thing without success. then I tried the c-collar. I could understand how it would work for jaw drop but was skeptical it would be effective against lip flutter. I'm still not really sure why it works but it does, even up to 25cm pressure. now I can't pap without it, much as I dislike wearing it, because it significantly reduces mouth leaks and has all but completely stopped my over-the-machine's-threshold leaks. at high pressure, aerophagia is unbearable without it too, although I couldn't tell you why it helps with that either. unfortunately the collar is hot and to be effective I have to wear it uncomfortably tight to keep my chin from slipping under. in addition, the $20 drug store variety that I use has compressed in a couple month's time to the point it's becoming a little less effective. I'm going to try wrapping some material around it to raise my chin some more. failing that, I can imagine needing 3-6 of them a year for maximum effect. there have been a number of alternate varieties to try that have been discussed around the forum in the last few months that might be better.

mouth leak is all too common a problem that has to be managed for the pap machines to be most effective. another benefit of managing mouth leak is to avoid the unpleasant drooling that goes hand in hand with open lips or mouth. solving the problem may take a lot of trial and error. as you can see from this thread what works for some may not work for others. let us know what ends up working best for you A33.